Senate amendments make the following changes to the 3rd edition.

Amendment #1 makes the following changes. 

Part I.

Changes the effective date of the provisions of Section 1.1, which (1) repeal Section 3, SL 2013-5, which bars the State from expanding the State's Medicaid eligibility under the Medicaid expansion provided in the Affordable Care Act, PL 111-148, as amended, and bars State entities from attempting to expand the Medicaid eligibility standards provided in SL 2011-145, as amended, or elsewhere in State law, unless directed by the NCGA and (2) amends GS 108A-54.3 to enact new subdivision (24), requiring the Department of Health and Human Services (DHHS) to provide Medicaid coverage to individuals described in section 1902(a)(10)(A)(i)(VIII) of the Social Security Act who are in compliance with work requirements established in the State Plan and in rule. Makes the provisions effective at the earlier of July 1, 2023, or the date that the work requirements developed under Part II. of the act become effective (was, effective upon the later of six months after the date the act becomes law, or on the date the work requirements developed under Part II. of the act become law). Makes a technical change to new GS 108A-54.3(24), to require individuals to be in compliance with any work requirements established in the State Plan. 

Changes the effective date of the provisions of Section 1.2, which (1) enacts GS 108A-54.3B, providing legislative intent to fully fund the nonfederal share of the cost of NC Health Works, meaning the provision of Medicaid coverage to the individuals described in new GS 108A-54.3A(24), through a combination of specified funding sources; establishes reporting requirements for DHHS; and requires expeditiously discontinuing coverage for the individuals described in new GS 108A-54.3A(24) if the nonfederal share of the cost cannot be fully funded through the described sources and (2) enacts GS 108A-54.3C to require expeditious discontinuation of Medicaid coverage if the federal medical assistance percentage for Medicaid coverage provided to the individuals described in new GS 108A-54.3A(24) falls below 90%, and establishes requirements identical to those for discontinuation due to insufficient funds from identified sources in GS 108A-54.3B. Makes provisions effective at the earlier of July 1, 2023, or the date that the work requirements developed under Part II. of the act become effective (was, effective upon the later of six months after the date the act becomes law, or on the date the work requirements developed under Part II. of the act become law).

Changes the application of Section 1.5, which establishes hospital health advancement assessments for licensed hospitals for State fiscal quarters beginning October 1, 2022, through December 31, 2022, and beginning January 1, 2023, and April 1, 2023. Makes the assessment rate described for quarters beginning January 1, 2023, and April 1, 2023, effective on the effective date of the Medicaid coverage described in Section 1.1 of the act, and sunsets the assessment rate on June 30, 2023. Adds that if the effective date of Medicaid coverage described in Section 1.1 of the act occurs after June 30, 2023, the assessment should not be imposed and no payments should be made to county departments. 

Part II.

Revises the leading language of Section 2, which directs DHHS to develop work requirements for certain individuals eligible for Medicaid under new GS 108A-54.3A(24) as a contingency to NC Health Works participation, aligned with the Able-Bodied Adults Without Independents (ABAWDs) policy under the Supplemental Nutrition Assistance Program (SNAP), to frame as legislative intent the provisions requiring certain individuals eligible for Medicaid under the new subdivision of GS 108A-54.3A be subject to work requirements as a contingency of NC Health Works participation, and frame the directive to DHHS to develop such work requirements as a means to meet that legislative intent. 

Regarding the directive to DHHS to submit necessary State Plan amendments and waivers to the Centers for Medicare and Medicaid Services (CMS) to implement the work requirements developed, now directs DHHS to submit waivers (no longer including State Plan amendments) to CMS, within 30 days of the date the act becomes law (was, by October 1, 2022). Now requires DHHS to request an effective date for the wavier that is no more than six months from the effective date of the act (was, request a date six months from the effective date of the act). Adds a new provision to require DHHS to continue to monitor developments on the federal level with regards to the imposition of work requirements as a contingency to eligibility for Medicaid coverage in the event the waiver is denied by CMS, and resubmit the waiver if there are new developments. Specifies that the provisions do not preclude the pursuit of any legal action by the State related to federal approval or disapproval of implementation of Section 2.

Amendment #2 makes the following changes.

Part III.

Adds to the proposed changes to GS 131E-183(a)(1), which replaces criteria for the issuance of a certificate of need to facilities listed in the subdivision, to include the following facilities: proposed projects for adult care home beds, nursing home beds, intermediate care beds for individuals with intellectual disabilities, home health agencies, home health agency offices, hospice offices, hospice inpatient facilities, hospice inpatient facility beds, hospice residential care facilities, and hospice residential care facility beds.